Clasp knife in the gut: a case report
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A wide range of foreign bodies has been retrieved from the gut and reported. The presentation may be in the form of complications like intestinal obstruction, perforation and formation of abscesses etc but there is no case report of a half open clasp knife being retrieved from the ileum, the patient having thrived, in spite of its presence for a period of eight months.
A 30-year-old administrative clerk had undergone emergency abdominal surgery eight months previously under mysterious circumstances at a remote district hospital and had recovered completely. Later the blade of a knife was accidentally detected when an X ray of the abdomen was done during a routine follow-up visit to his family physician. Surgery revealed a clasp knife in the ileum, which was retrieved. The presence of an entero-enteric fistula short circuiting the loop was the secret of his earlier survival.
To the best of our information this is the first case-report of a clasp knife in the gut and of the patient thriving in spite of its presence. We report here the dramatic sequence of events.
KeywordsClasp knife Ileum
A wide range of penetrating foreign bodies have been retrieved from the gut such as needles, toothpicks, blades, nails and pencils etc. [1, 2, 3]. The presentation may come as a radiological or an operative surprise if the history is not forthcoming. In the reported case the blade of a kitchen knife was detected as a radiological surprise.
Following the second operation his post-operative recovery was good. After discharge he recovered completely and uneventfully. He was subsequently treated at our psychiatric center for MDP (Maniac Depression Psychosis). Nearly two years of follow-up revealed a continued satisfactory recovery.
We were not able to find out how the knife was missed during the first operation No details could be obtained from the district hospital except that an exploratory laparotomy was performed and the patient had had an uneventful recovery.
To the best of our information there is no case report of retrieval of a clasp (half-cocked) knife from the gut of a healthy individual, who was thriving well in spite of its presence for eight months.
This miraculous story of survival and the dramatic sequence of events reinforce the age-old belief that "life always finds its way".
A wide spectrum of foreign bodies retrieved from the gut has been reported [1, 2, 3]however the reported incidence of foreign bodies penetrating the gut is less than 1%, such objects being pointed or sharp in most of the cases, for example tooth picks, sewing needles, dental plates, fish and chicken bones etc. [1, 3]. A foreign body in the gut may remain silent or may be detected incidentally during investigations. The diagnosis is usually straightforward if the patient reports with a history of incidental or accidental penetration of the abdomen by a foreign body. Otherwise an abdominal x-ray, or an ultrasound examination, or a computed tomographic scan may be required if the diagnosis is in doubt or if, as in this case, the history is not forthcoming [4, 5, 6]. A foreign body may also present as an associated complication like an abscess, a fistula or may migrate to sites like the liver etc.
This case is of interest because the presence of an internal entero-enteric fistula ensured a free passage of the intestinal contents in spite of the clasp knife obstructing the lumen, thus ensuring his survival.
A written consent was obtained from the patient regarding publication of the patient's details.
- 2.Maleki M, Evans WE: Foreign body perforation of the intestinal tract. Report of 12 cases and review of literature. Arch Surg. 1970, 102: 227-228.Google Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2482/3/12/prepub
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